title: Quantitative serum toxic screening in the management of suspected drug overdose.
abstract: Data were collected on 176 consecutive cases of drug overdose evaluated in an emergency department. Quantitative serum toxic screening (TS) was performed for 164 (93%) of these patients; positive results were noted for 133 patients (81%). Six classes of drugs (ethanol, benzodiazepines, salicylates, acetaminophen, barbiturates, and tricyclic antidepressants) were responsible for nearly 70% of all drug detections and were associated with 80% of all admissions in this patient sample. Only two patients (1%) had drug-specific treatment initiated because of TS results. In 12 patients (7%), TS confirmed substances for which specific treatments had been initiated on clinical grounds. Four patients (2%) had drug-specific treatment discontinued because of TS results. Thirty-two patients (19%) were admitted to a medical service; however, only seven patients (4%) were admitted primarily because of TS results. All other patients were admitted because of clinical abnormalities that required inpatient care. It is concluded that only a few drugs are responsible for most drug overdoses. Moreover, TS results rarely change the treatment or disposition of overdose patients; these decisions are typically based on clinical parameters.
authors.affiliation: Emergency Services Department, Massachusetts General Hospital, Boston 02114.
authors.forename: J D
authors.initials: JD
authors.lastname: Mahoney
authors.forename: P L
authors.initials: PL
authors.lastname: Gross
authors.forename: T A
authors.initials: TA
authors.lastname: Stern
authors.forename: B J
authors.initials: BJ
authors.lastname: Browne
authors.forename: M H
authors.initials: MH
authors.lastname: Pollack
authors.forename: V
authors.initials: V
authors.lastname: Reder
authors.forename: A G
authors.initials: AG
authors.lastname: Mulley
mesh_terms: D000082:Acetaminophen / Q000097:blood / Q000506:poisoning; D000435:Alcoholic Intoxication / Q000097:blood / Q000175:diagnosis; D000929:Antidepressive Agents, Tricyclic / Q000097:blood / Q000506:poisoning; D001463:Barbiturates / Q000097:blood / Q000506:poisoning; D001774:Blood Chemical Analysis / Q000592:standards*; D003975:Diazepam / Q000097:blood / Q000506:poisoning; D062787:Drug Overdose / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D004630:Emergencies; D006801:Humans; D012189:Retrospective Studies; D012459:Salicylates / Q000097:blood / Q000506:poisoning
chemical_list: D000929:Antidepressive Agents, Tricyclic; D001463:Barbiturates; D012459:Salicylates; D000082:Acetaminophen; D003975:Diazepam